OMB#: 0925-0648 ExpDate: 05/2021
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.
Page exit logic: Skip / Disqualify LogicIF: #1 Question
"Please select your employment type." is one of the
following answers ("Contractor") THEN: Disqualify
and display: "Thank you for your interest in the survey!
At this time, we are only able to collect input from the NIH federal
employees and you have indicated you currently serve as a
contractor.
Please continue to check the NIH
COVID intranet site for updates regarding our return to the
physical workspaces and other guidance. The NIH COVID intranet site
also contains a wellness
page that contains a collection of videos and other resources
from NIH to support your emotional, mental, and physical
well-being.
If you have additional questions about NIH’s
return efforts, please contact
CoronavirusStaffQuery@od.nih.gov.
"
( ) Federal Employee
( ) Fellow/Trainee
( ) Contractor
Page exit logic: Skip / Disqualify LogicIF: #2 Question
"Have you already returned to the worksite in Groups 0, A, B, or
B2?" is one of the following answers ("Yes","I am
a permanent remote worker (e.g., I teleworked full time prior to
COVID)") THEN: Disqualify and display: "Thank you
for your interest in the survey! At this time, we are only
collecting input from NIH federal employees who may be eligible to
return in Group C (non-permanent remote workers and who have not
returned to the worksite in Groups 0, A, B, or B2).
Please
continue to check the NIH
COVID intranet site for updates regarding our return to the
physical workspaces and other guidance. The NIH COVID intranet site
also contains a wellness
page that contains a collection of videos and other resources
from NIH to support your emotional, mental, and physical
well-being.
If you have additional questions about NIH’s
return efforts, please contact
CoronavirusStaffQuery@od.nih.gov.
"
( ) Yes
( ) No
( ) I am a permanent remote worker (e.g., I teleworked full time prior to COVID)
( ) CC
( ) CIT
( ) CSR
( ) FIC
( ) NCATS
( ) NCCIH
( ) NCI
( ) NEI
( ) NHGRI
( ) NHLBI
( ) NIA
( ) NIAAA
( ) NIAID
( ) NIAMS
( ) NIBIB
( ) NICHD
( ) NIDA
( ) NIDCD
( ) NIDCR
( ) NIDDK
( ) NIEHS
( ) NIGMS
( ) NIMH
( ) NIMHD
( ) NINDS
( ) NINR
( ) NLM
( ) OD
( ) ORF
( ) ORS
Logic: Show/hide trigger exists.
( ) Argonne, IL
( ) Baltimore, MD
( ) Bethesda, MD Campus
( ) Bethesda, MD Naval Med Ctr
( ) Bethesda, MD Off Campus
( ) Boston, MA
( ) Detroit, MI
( ) Framingham, MA
( ) Frederick, MD
( ) Gaithersburg, MD
( ) Glen Dale, MD
( ) Jackson, MS
( ) Kensington, MD
( ) New Iberia, LA
( ) Phoenix, AZ
( ) Poolesville, MD
( ) RTP, NC
( ) Rancho Cordova, CA
( ) Rockville, MD
( ) Rocky Mt. Labs, MT
( ) Waltham, MA
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Other")
_________________________________________________
Page exit logic: Skip / Disqualify LogicIF: #5 Question
"If NIH deems it acceptable to proceed with a Group C, are you
interested in voluntarily returning as a part of that group? The
NIH
Framework for Return to Physical Workspaces defines Group C as
staff who can successfully telework but are willing and able to
return on site. At this time, we anticipate that there
would be an initial call for volunteers with subsequent
opportunities. Completion of this survey is not an application
to return." is one of the following answers ("No")
THEN: Disqualify and display: "Your response has been
captured. At this time, we are only collecting additional input
from the NIH federal employees who are interested in voluntarily
returning to the worksite in Group C.
Please continue to
check the NIH
COVID intranet site for updates regarding our return to the
physical workspaces and other guidance. The NIH COVID intranet site
also contains a wellness
page that contains a collection of videos and other resources
from NIH to support your emotional, mental, and physical
well-being.
If you have additional questions about NIH’s
return efforts, please contact
CoronavirusStaffQuery@od.nih.gov.
"
( ) Yes, on a full-time basis
( ) Yes, on a part-time basis
( ) No
( ) Prefer the office environment
( ) Personal well-being improvement
( ) More reliable internet and IT in the office
( ) Proximity between my childcare and the worksite
( ) Other (please specify): _________________________________________________*
( ) 1
( ) 2
( ) 3
( ) 4
( ) 5
( ) 6
( ) 7
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Argonne, IL")
( ) 202 - Argonne National Laboratory
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Baltimore, MD")
( ) BRC - Biomedical Research Center
( ) C
( ) HARBOR - Harbor Hospital
( ) TAWES - MPRC
( ) TRIAD - Triad Tech Ctr
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Bethesda, MD Campus")
( ) 1 - Shannon Building
( ) 2
( ) 3
( ) 4
( ) 5
( ) 6
( ) 6A
( ) 6B
( ) 8
( ) 9
( ) 10 - Magnuson Clinical Center
( ) 10 - CRC - Hatfield Clinical Research
( ) 11
( ) 12
( ) 12A
( ) 12B
( ) 13
( ) 14A
( ) 14B
( ) 14C
( ) 14D
( ) 14E
( ) 14F
( ) 14G
( ) 14H
( ) 14J
( ) 15B1
( ) 15B2
( ) 15C1
( ) 15C2
( ) 15D1
( ) 15D2
( ) 15E1
( ) 15E2
( ) 15F1
( ) 15F2
( ) 15G1
( ) 15G2
( ) 15H
( ) 15I
( ) 15K
( ) 16
( ) 16A - Fogarty International Center
( ) 17
( ) 18
( ) 18T
( ) 20
( ) 21
( ) 22
( ) 22A
( ) 23 - Child Care Center
( ) 25
( ) 26
( ) 28
( ) 28A
( ) 29
( ) 29A
( ) 29B
( ) 30
( ) 30T
( ) 31 - Claude D Pepper Building
( ) 32
( ) 32A
( ) 32TI
( ) 32TII
( ) 33 - C W Bill Young Center
( ) 34
( ) 35 - Porter Building
( ) 35A
( ) 37
( ) 38 - National Library of Medicine
( ) 38A - Lister Hill Center
( ) 40 - Vaccine Research Center
( ) 41
( ) 45 - Natcher Building
( ) 46
( ) 49
( ) 50 - Louis B Stokes Lab
( ) 51
( ) 52
( ) 53
( ) 54
( ) 58
( ) 60 - Mary Woodard Lasker Center
( ) 61
( ) 61A
( ) 62 - Children's Inn at NIH
( ) 64 - East Child Care Ctr
( ) 65 - Edmond J Safra Family Lodge
( ) 66 - Gateway Center
( ) 66A - Gateway Inspection Center
( ) 67
( ) 68
( ) 82 - R A Bloch International Cancer Center
( ) T02
( ) T03
( ) T04
( ) T14 - Warehouse
( ) T20
( ) T23
( ) T28
( ) T39 - Fitness Center
( ) T41
( ) TR10A
( ) TR10B
( ) TR10B1
( ) TR10B2
( ) TR10B4
( ) TR10C2
( ) TR15
( ) TR21A
( ) TR21B
( ) TR30B
( ) TR36A
( ) TR37A
( ) TR40A
( ) TR40B
( ) TR46
( ) TR46B
( ) TR46E
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Bethesda, MD Naval Med Ctr")
( ) 8
( ) 43
( ) 46
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Bethesda, MD Off Campus")
( ) 1DEM - One Democracy Plz
( ) 2DEM - 2 Democracy Plaza
( ) 5413 - 5413 West Cedar Ln
( ) 5415 - 5415 West Cedar Ln
( ) 6700A - 6700A Rockledge Drive
( ) 6700B - 6700B Rockledge Drive
( ) 6710B - 6710B Rockledge Drive
( ) 7700
( ) 8601 - 8601 Old Georgetown Road
( ) 8697
( ) BSA - Boy Scouts of America Building
( ) FASEB - Fed of Amer Soc for Exp Biology
( ) FERN - Fernwood
( ) GWY - Gateway Building
( ) RKL1 - One Rockledge Center
( ) RKL2 - Two Rockledge Center
( ) WB - Westwood Building
( ) W Cedar - 5411 - 15 W Cedar Ln (Doctor Park)
( ) BC T32-1 - NIHBC T32-1
( ) BC T32-2 - NIHBC T32-2
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Boston, MA")
( ) JFK - JKF Building
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Detroit, MI")
( ) HUTZEL - Hutzel Hospital
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Framingham, MA")
( ) PERINI - Perini Building
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Frederick, MD")
( ) 244 - FCRDC
( ) 310 - FCRDC
( ) 311
( ) 312 - FCRDC
( ) 313A - FCRDC
( ) 314 - FCRDC
( ) 315 - FCRDC
( ) 318 - FCRDC
( ) 319 - FCRDC
( ) 320 - FCRDC
( ) 321 - FCRDC
( ) 322 - FCRDC
( ) 323 - FCRDC
( ) 324 - FCRDC
( ) 325 - FCRDC
( ) 327 - FCRDC
( ) 347 - FCRDC
( ) 349 - FCRDC
( ) 350 - FCRDC
( ) 359
( ) 360 - FCRDC
( ) 361 - FCRDC
( ) 362 - FCRDC
( ) 363 - FCRDC
( ) 371 - FCRDC
( ) 372 - FCRDC
( ) 376 - FCRDC
( ) 378 - FCRDC
( ) 381 - FCRDC
( ) 425 - FCRDC
( ) 426 - FCRDC
( ) 427 - FCRDC
( ) 428 - FCRDC
( ) 429 - FCRDC
( ) 430 - FCRDC
( ) 431 - FCRDC
( ) 432 - FCRDC
( ) 433 - FCRDC
( ) 434 - FCRDC
( ) 440 - FCRDC
( ) 441 - FCRDC
( ) 457 - FCRDC
( ) 458 - FCRDC
( ) 459 - FCRDC
( ) 469 - FCRDC
( ) 472 - FCRDC
( ) 535 - FCRDC
( ) 536 - FCRDC
( ) 538 - FCRDC
( ) 539 - FCRDC
( ) 542 - FCRDC
( ) 549 - FCRDC
( ) 550 - FCRDC
( ) 558 - FCRDC
( ) 559 - FCRDC
( ) 560 - FCRDC
( ) 562 - FCRDC
( ) 567 - FCRDC
( ) 571 - FCRDC
( ) 576 - FCRDC
( ) 578 - FCRDC
( ) 1003 - FCRDC
( ) 1011 - FCRDC
( ) 1019
( ) 1021 - FCRDC
( ) 1022 - FCRDC
( ) 1023 - FCRDC
( ) 1025 - FCRDC
( ) 1026 - FCRDC
( ) 1027 - FCRDC
( ) 1029 - FCRDC
( ) 1031 - FCRDC
( ) 1032 - FCRDC
( ) 1033 - FCRDC
( ) 1034 - FCRDC
( ) 1035 - FCRDC
( ) 1036 - FCRDC
( ) 1037 - FCRDC
( ) 1038 - FCRDC
( ) 1040 - FCRDC
( ) 1043 - FCRDC
( ) 1044 - FCRDC
( ) 1045 - FCRDC
( ) 1046 - FCRDC
( ) 1047 - FCRDC
( ) 1048 - FCRDC
( ) 1049 - FCRDC
( ) 1050 - FCRDC
( ) 1051 - FCRDC
( ) 1062 - FCRDC
( ) 1063 - FCRDC
( ) 1064 - FCRDC
( ) 1066 - FCRDC
( ) 1067 - FCRDC
( ) 1068 - FCRDC
( ) 1069 - FCRDC
( ) 1070 - FCRDC
( ) 1071 - FCRDC
( ) 1072 - FCRDC
( ) 1073 - FCRDC
( ) 1074 - FCRDC
( ) 1075 - FCRDC
( ) 1722 - FCRDC
( ) 5705IL - 5705 Industry Ln
( ) 7116 - 7116 Geoffrey Way
( ) 8225
( ) IRF - Integrated Research Facility
( ) RIVER5 - RIVERSIDE5
( ) WW
( ) FDC 8490
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Gaithersburg, MD")
( ) 8402 - Helgerman Ct
( ) ATC - Advanced Technology Ctr
( ) GDC - Gaithersburg Distribution Center
( ) MDL9 - 9 West Watkins Mill Rd
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Glen Dale, MD")
( ) MATLAND - Matland Warehouse
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Jackson, MS")
( ) JMM - Jackson Medical Mall
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Kensington, MD")
( ) NLRC - Nicholson Lane Research Center
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("New Iberia, LA")
( ) N1 10 - Building N1 10
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Phoenix, AZ")
( ) GENOME - Genomics Building
( ) PECRB
( ) PIMC
( ) S Avenida - 8619 S. Avenida
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Poolesville, MD")
( ) 101 - NIH Animal Center
( ) 102 - NIH Animal Center
( ) 103 - NIH Animal Center
( ) 104 - NIH Animal Center
( ) 107 - Electrical Switchgear
( ) 110 - NIH Animal Center
( ) 110A - NIH Animal Center
( ) 111 - NIH Animal Center
( ) 112 - NIH Animal Center
( ) 115 - NIH Animal Center
( ) 116 - NIH Animal Center
( ) 117 - NIH Animal Center
( ) 130 - NIH Animal Center
( ) 131 - NIH Animal Center
( ) 132 - NIH Animal Center
( ) T01 - NIH Animal Center
( ) T02 - NIH Animal Center
( ) T05 - NIH Animal Center
( ) T06 - NIH Animal Center
( ) T07 - NIH Animal Center
( ) T10 - NIH Animal Center
( ) T11 - NIH Animal Center
( ) T12 - NIH Animal Center
( ) T13 - NIH Animal Center
( ) T14 - NIH Animal Center
( ) T15 - NIH Animal Center
( ) T16 - NIH Animal Center
( ) T19
( ) T20
( ) T23 - NIH Animal Center
( ) T25 - NIH Animal Center
( ) T25A - NIH Animal Center
( ) T25B - NIH Animal Center
( ) T25C - NIH Animal Center
( ) T39 - NIH Animal Center
( ) T41 - NIH Animal Center
( ) T46 - NIH Animal Center
( ) AC 101A - NIHAC 101A
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("RTP, NC")
( ) 101 - Rail Building
( ) 102 - Facilities Engineering
( ) 103 - Chemical Storage
( ) 104 - Warehouse
( ) 105 - Central Utility Plant
( ) 108 - Waste Holding
( ) 109 - Modular Clinic
( ) 110 - Receiving Warehouse
( ) 111
( ) KEYSTN - Keystone Building
( ) MRI
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Rancho Cordova, CA")
( ) Mercantile - 2750 Mercantile Dr.
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Rockville, MD")
( ) E Gude Dr - 1029 E Gude DR
( ) 1700RB - 1700 Research Blvd
( ) 2115EJ - 2115 E Jefferson St
( ) 4930
( ) 5601FL - 5601 Fishers Ln
( ) 5625FL - 5625 Fishers Ln
( ) 5635FL - 5635 Fishers Ln
( ) 6006 - 6006 Executive Boulevard
( ) 6011 - 6011 Exec Boulevard
( ) 6100 - Executive Building
( ) 6101 - 6101 Exec Blvd
( ) 9615 - 9615 Medical Center Drive
( ) 9609 - 9609 Medical Center Dr
( ) 9610 - Key West Medical Center
( ) 9800A - 9800A Medical Center Dr-Bldg A
( ) 9800B - 9800B Medical Center Dr-Bldg B
( ) 9800C - 9800C Medical Center Dr-Bldg C
( ) 11601 - Landsdown St
( ) BBW - Boiling Brook Warehouse
( ) DANAC - DANAC Warehouse
( ) FLOW - Flow Building
( ) NSA - Stonestreet Printing/Mail
( ) NSC - Neuro Science Center
( ) PICCRD - 1375 Piccard Dr
( ) RKW1 - Rockwall I
( ) RKW2 - Rockwall II
( ) TW1 - Twinbrook I
( ) TW2 - Twinbrook II
( ) TW3 - Twinbrook III
( ) WILLCO - Willco Building
( ) WOC1 - Woodmont Office Center 1
( ) WOC2 - Woodmont Office Center 2
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Rocky Mt. Labs, MT")
( ) 1
( ) 2
( ) 3
( ) 5
( ) 6
( ) 7
( ) 8
( ) 9
( ) 11
( ) 12
( ) 13
( ) 13B
( ) 22
( ) 25
( ) 26
( ) 28
( ) 29
( ) 30
( ) 31
( ) 32
( ) A
( ) ARMCO
( ) HD-1
( ) HD-2
( ) T-23
( ) Other
Logic: Hidden unless: #4 Question "Where is your official worksite?" is one of the following answers ("Waltham, MA")
( ) WFC - Waltham Federal Center
( ) Other
Logic: Hidden unless: ((((((((((((((((((((#8 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other") OR #9 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #10 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #11 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #12 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #13 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #14 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #15 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #16 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #17 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #18 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #19 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #20 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #21 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #22 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #23 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #24 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #25 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #26 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #27 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other")) OR #28 Question "If you were to return in Group C, what building would you be working in (e.g., the building you would be reporting to if you were not teleworking)?" is one of the following answers ("Other"))
_________________________________________________
( ) Private Office
( ) Cubicle
( ) Open Floor Plan
( ) Other (Please Specify): _________________________________________________*
( ) Drive Personal Vehicle
( ) Carpool
( ) Vanpool
( ) Public Transportation (Metro, Bus, etc.)
( ) Other
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Chen, Sylvia (NIH/OD) [E] |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |